CAG slams Def Min over poor execution of health scheme for

Top government auditor has slammed the Defence Ministry over alleged "irregularities" and "deficiency" in the implementation of the Ex-servicemen Contributory Health Scheme which caused the exchequer a loss of over Rs 100 crore.
The Comptroller and Auditor General of India (CAG) also brought out various shortcomings in the implementation like short supply of medicines to the polyclinics, raising of two claims for the same patients during the overlapping period, irregular payment towards unaccounted bills of empanelled hospitals among others.
The schemes aims to provide health care to around 47 lakh beneficiaries on a cashless basis in line with Central Government health Scheme (CGHS) through a network of 426 polyclinics, service hospitals and private empanelled hospitals spread over the country.

The CAG said availability of medicines, medical equipment, manpower were inadequate in these polyclinics due to which they were forced to function as point of referral of patients to the empanelled hospitals/labs, which consumed about 70 per cent of revenue expenditure of the scheme.
Moreover, funds allotted for the scheme for procurement of medicines/stores were diverted or utilized for treatment of regular service personnel to the extent of Rs 40.78 crore, the report said.
The report highlighted the irregular payment of Rs 23.61 crore made by Station Hqrs (ECHS Cell), Delhi Cantt against the unaccounted bill involving double payments against a particular bill/duplicate bills.

The report also highlighted unethical practices adopted by the empanelled hospitals such as raising of inflated bills for the treatment of indoor patients involving overpayment of Rs 3.51 crore. It said claims amounting to Rs 42.67 lakh were raised simultaneously by two empanelled hospitals for the same patient and for the same time period.

Besides, the CAG also found discrepancies in enrolment of
beneficiaries. It said instead of free issue of smart cards, the beneficiaries were being charged, while there were also instances of their multiple enrolment of beneficiaries, raising the possibility of misuse of smart cards. It also pointed out alleged lapses in issue of smart card to ineligible beneficiaries.

Further, the outsourced Bill Processing Agency (BPA) responsible for online processing of medical claims was functioning without Memorandum of agreement (MoA) since its inception in 2012. In the absence of MoA, no performance parameters were enforcible on BPA with the result that two per cent discount available on payment made to empanelled hospitals within 10 working days was not obtained. It said the discount totalling Rs 34.10 crore on payment made to hospitals could not be availed due to delayed processing of bills.
The CAG said an agreement was entered into with SITL (Score Information Technologies Limited), by the Managing Director, ECHS, Delhi Cantonment in January 2004 for supply of smart cards at Rs 89.99 apiece for a period of five years, later extended for one more year.

Audit observed that without adhering to the laid down provisions for the repetition of orders, Central Organisation, ECHS renewed the agreement with the same firm in May 2010 for supply of smart cards at an increased cost of Rs 135 each.
"Further against the spirit of the Government sanction which stipulated that only one-time contribution towards membership fees at the rates prescribed for CGHS pensioners was to be recovered from ECHS subscribers, Central organisation ECHS recovered the cost of smart cards from the ECHS beneficiaries.
"This recovery of cost was done without the approval of the MoD (Ministry of Defence), thereby putting the ECHS beneficiaries to a disadvantage as against the CGHS beneficiaries," the report said.

CAG said it was found during the audit that ECHS had issued 7,431 cards in excess of the total number produced by SITL. Holding and circulation of excess cards posed a significant risk of possible misuse, it said.